Socioeconomic Inequalities In Morbidity Research Articles

Characteristics of the Third COVID-19 Pandemic Wave with Special Focus on Socioeconomic Inequalities in Morbidity, Mortality and the Uptake of COVID-19 Vaccination in Hungary.

Governments are increasingly looking to vaccination to provide a path out of the COVID-19 pandemic. Hungary offers an example to investigate whether social inequalities compromise what a successful vaccine program can achieve. COVID-19 morbidity, mortality, and vaccination coverage were characterized by calculation of indirectly standardized ratios in the Hungarian population during the third pandemic wave at the level of municipalities, classified into deprivation quintiles. Then, their association with socioeconomic deprivation was assessed using ecological regression. Compared to the national average, people living in the most deprived municipalities had a 15–24% lower relative incidence of confirmed COVID-19 cases, but a 17–37% higher relative mortality and a 38% lower vaccination coverage. At an ecological level, COVID-19 mortality showed a strong positive association with deprivation and an inverse association with vaccination coverage (RRVaccination = 0.86 (0.75–0.98)), but the latter became non-significant after adjustment for deprivation (RRVaccination = 0.95 (0.84–1.09), RRDeprivation = 1.10 (1.07–1.14)). Even what is widely viewed as one of the more successful vaccine roll outs was unable to close the gap in COVID-19 mortality during the third pandemic wave in Hungary. This is likely to be due to the challenges of reaching those living in the most deprived municipalities who experienced the highest mortality rates during the third wave.

Socioeconomic inequalities in morbidity: Results from Serbian National Health Surveys

Background The greatest contribution to inequalities in health both within and between countries is attributable to the socioeconomic determinants of health. The lower the socioeconomic status, the higher the probability of reporting a poor self-perceived health and the higher the prevalence of health problems and chronic conditions. The aim of this study was to examine the associations between sociodemographic determinants and morbidity of the population by using specially constructed morbidity indices, and to analyze and …

Why are Socioeconomic Inequalities in Receipt of Treatment Found for Lung Cancer?

177 ISSN 1758-1966 10.2217/LMT.13.12 © 2013 Future Medicine Ltd Lung Cancer Manage. (2013) 2(3), 177–180 Intervention-generated inequalities We would hope that interventions to improve health would also reduce health inequalities, but this is not always the case [1]. Evidence is accumulating that effective treatments for lung cancer are not equally received by individuals across the socioeconomic spectrum [2]. Intervention-generated inequalities (IGIs) have been described as “unintended (and unwanted) variations in outcomes, across population subgroups, that result from any element of any health intervention” [3], where, although overall population health may improve as the result of an intervention, differences in access to the intervention, differential uptake, delays in uptake and differential compliance with, or differences in effectiveness of, an intervention may result in inequalities in outcome [3,4]. The IGI framework expands on previous equity hypotheses that have attempted to describe variations in the provision and uptake of interventions. The ‘inverse care law’ states that “the availability of good quality healthcare is inversely related to need in the population served” [5]. The ‘inverse prevention law’ suggests that a similar socioeconomic gradient also exists in health prevention [6], and the ‘inverse equity hypothesis’ proposed that public health interventions initially widen socioeconomic inequalities due to preferential uptake by more advantaged groups before the less advantaged follow suit, eventually improving health overall [7]. However, none of the above equity laws/hypotheses consider how interventions can be designed to reduce inequality. In order to expand these equity laws into an evidence-based framework and model of intervention inequality, it is necessary to examine all the possible stages where inequalities may be introduced and consider ways in which these can be addressed, as it is likely that IGIs contribute to overall socioeconomic inequalities in morbidity and mortality [3].

Utility of data from a national health survey: Do socioeconomic inequalities in morbidity exist in Serbia?

The aim of this study was to analyse the impact of demographic and socioeconomic factors on morbidity in Serbia. Additionally, knowing that there is no a gold standard for measuring morbidity we were concerned whether the results of this study depend on the choice of morbidity indicator. Data from the 2006 National Health Survey for Serbia were used. A representative sample of 14,522 persons aged ≥20 years were interviewed. The associations between demographic factors (age, gender, marital status, and type of settlement), socioeconomic indicators (education and wealth index), and health status (morbidity index derived from self-reported data) were examined using linear and logistic regression analyses. Women, elderly people, those who live in urban settings, and those with lower education had higher morbidity regardless of using a morbidity index as a continuous variable (composite index ranging from 0 to 20) or a categorical variable (morbidity status tertiles). Respondents who belong to the most deprived group had higher scores of morbidity index in comparison with the respondents from the most affluent group, but no significant association was found when morbidity status was examined as the outcome. In addition, when those who belong to the middle class group were compared to the most affluent group, they had good more frequently than average morbidity status. This study suggests that demographic and socioeconomic inequalities in morbidity exist in Serbia. Wise and comprehensive health policies and interventions for reducing these inequalities are urgently needed which primarily focus on the most disadvantaged socioeconomic groups.

Causality, social selectivity or artefacts? Why socioeconomic inequalities in health are not smallest in the Nordic countries

The Nordic welfare states aim at providing equality of the highest standards for all their citizens. However, numerous studies have demonstrated that socioeconomic inequalities in morbidity and mortality are not among the smallest in these countries as compared with other European regions.1–7 Recently, this has spurred health researchers to evaluate the extent to which the Nordic welfare regime is capable of diminishing socioeconomic health inequalities.8,9 After all, the conclusion that the Nordic welfare regime does not succeed in reducing health inequalities would have serious implications for health policy world wide. In this commentary, we aim at evaluating why the Nordic welfare regime does not completely succeed in reducing socioeconomic inequalities in health, despite its egalitarian nature. Our presentation is divided into three types of explanations: causality, social selectivity and artefacts. Scholars have generally argued that a distinction should be made between relative and absolute socioeconomic health inequalities. Moreover, the absolute health status of the weakest socioeconomic groups (e.g. manual workers) is considered to be most important as a marker of the ability of welfare regimes to reduce socioeconomic disparities in health. Using this distinction, it was concluded that whereas the Nordic countries perform only intermediately whenever relative inequalities are considered, they have lower absolute inequalities and a higher average absolute health status of the lowest socioeconomic groups as compared with other European societies (although this applies mostly to Sweden and Norway, and only to a lesser extent to Denmark and Finland). Since the authors argue that welfare regime performance should mainly be evaluated …

Higher levels of education may be a marker of higher disease-specific knowledge in patients with chronic heart failure

the EU Working Group on Socioeconomic Inequalities in Health. Socioeconomic inequalities in morbidity and mortality in Western Europe. Lancet 1997;349:1655–9. [3] Dalstra JAA, Kunst AE, Mackenbach JP, The EU Working Group on Socioeconomic Inequalities in Health. A comparative appraisal of the relationship of education, income and housing tenure with less than good health among the elderly in Europe. Soc Sci Med 2006;62:2046–60. [4] Tibazarwa K, Ntyintyane L, Sliwa K, et al. A time bomb of cardiovascular risk factors in South Africa: results from the Heart of Soweto Study “Heart Awareness Days”. Int J Cardiol 2009;132:233–9. [5] Webel AR, Frazier SK, Moser DK, Lennie TA. Daily variability in dyspnea, edema, and body weight in heart failure patients. Eur J Cardiovasc Nurs 2007;6:60–5. [6] Pattenden JF, Roberts H, Lewin RJP. Living with heart failure: patient and carer perspective. Eur J Cardiovasc Nurs 2007;6:273–9. [7] van der Wal MH, Jaarsma T, Moser DK, Veeger NJ, van Gilst WH, van Veldhuisen DJ. Compliance in heart failure patients: the importance of knowledge and beliefs. Eur Heart J 2006;27:434–40. [8] Lainscak M, Cleland JGF, Lenzen MJ, et al. Patient recall of lifestyle advice in patients recently hospitalized with heart failure: a EuroHeart Failure survey analysis. Eur J Heart Fail 2007;9:1095–103. [9] Lainscak M, Keber I. Patients knowledge and beta blocker treatment improve prognosis of patients from heart failure clinic. Eur J Heart Fail 2006;8:187–90. [10] Jaarsma T, Van der Wal MHL, Lesman-Leegte I, et al. Effect of moderate or intensive disease management program on outcome in patients with heart failure. The Coordinating study evaluating Outcomes of Advising and Counseling in Heart Failure (COACH). Arch Intern Med 2008;168:316–24. [11] Coats AJ. Ethical authorship and publishing. Int J Cardiol 2009;131:149–50.

Did socioeconomic inequalities in morbidity and mortality change in the United States over the course of the twentieth century?

In this article we present two sets of empirical analyses that consider the extent to which socioeconomic gradients in self-assessed health and child mortality changed since the beginning of the twentieth century in the United States. This empirical issue has important and wide-ranging research and policy implications. In particular, our results speak to the value of considering the role of broader social, economic, and political inequalities in generating and maintaining socioeconomic disparities in morbidity and mortality. Despite dramatic declines in morbidity and mortality rates in the United States across the twentieth century, we find that socioeconomic-status gradients in morbidity and mortality declined only modestly (if at all) during that period.

Subjective socioeconomic position, gender and cortisol responses to waking in an elderly population

Socioeconomic inequalities in morbidity and mortality exist, but the psychobiological pathways that link social status and health are less clear. It has previously been reported that socioeconomic status is inversely associated with the magnitude of the cortisol response to awakening (CAR) in men and women of working age. In the present study, we tested whether larger cortisol responses would be present in an older retired population, and whether the CAR differed between men and women. The extent to which adherence to saliva sample timing also affects the CAR was investigated. Ninety three men and women aged 65-80 years took saliva samples on waking, and then 10, 20, 30 and 60 min after waking. Subjective social status was assessed using the 'ladder' measure devised by Adler et al. (2000). Non-compliance was defined as a reported delay of 10 min or more between waking and taking the first saliva sample. Cortisol levels on waking were significantly higher in the non-compliant individuals, and the CAR was blunted compared with that of compliant participants. With non-compliant participants eliminated from the analyses, we found that low social status was associated with a larger CAR after adjusting for gender, waist/hip ratio, body mass index, smoking, time of waking, chronic illness, prescription medication, education and financial strain. No association was found between CAR and education or financial strain. Women also had significantly larger CARs, independent of socioeconomic position. The results highlight the importance of controlling for non-compliance and are consistent with the notion that higher socioeconomic position protects against stress-related activation of psychobiological pathways which may contribute to variation in disease risk evident in old age.

Socioeconomic inequalities in morbidity among the elderly; a European overview

There is some evidence on socioeconomic inequality in morbidity among elderly people, but this evidence remains fragmentary. This study aims to give a comprehensive overview of educational and income inequalities in morbidity among the elderly of eleven European countries. Data from the first wave of 1994 of the European Community Household Panel were used. The study population comprised a total of 14,107 men and 17,243 women, divided into three age groups: 60–69, 70–79 and 80+. Three health indicators were used: self-assessed health, cut down in daily activities due to a physical or mental problem, and long-term disability. The results indicate that socioeconomic inequalities in morbidity by education and income exist among the elderly in Europe, in all the countries in this study and all age groups, including the oldest old. Inequalities decline with age among women, but not always among men. Greece, Ireland, Italy and The Netherlands most often show large inequalities among men, and Greece, Ireland and Spain do so among women. To conclude, inequalities in morbidity decrease with age, but a substantive part persists in old age. To improve the health of elderly people it is important that the material, social and cultural resources of the elderly are improved.

Workplace demands, economic reward, and progression of carotid atherosclerosis.

Characteristics of the work environment have been associated with cardiovascular morbidity and mortality, but it is unclear whether these factors are associated with preclinical manifestations of disease. We investigated the association between job demands, economic reward, and the 4-year progression of carotid atherosclerosis in a population-based sample of 940 Finnish men. Data from the Kuopio Ischemic Heart Disease Risk Factor Study were used to estimate changes in plaque height, maximum and mean intima-media thicknesses across combinations of job demands, and income. Associations were examined in relation to atherosclerotic risk factors and were stratified by baseline levels of atherosclerosis and prevalent ischemic heart disease. Men who had jobs with high demands and low economic rewards had significantly greater 4-year progression of plaque height (0.33 mm, P = .008) and maximum intima-media thickness (0.32, P = .03) than men with low-demand, high-income jobs. The magnitude of these differences was not greatly attenuated by risk factor adjustment and did not differ when examined by the level of workplace resources, social support, or employment status. Larger differences were observed in a subsample of men who had more advanced atherosclerosis at baseline. These results show that men with demanding work that produces little economic reward have significantly greater progression of carotid atherosclerosis than more advantaged men. The relationship between job demands and health should be understood in a broad framework of interacting economic conditions, social circumstances, and behaviors that cascade over the life course and may ultimately contribute to socioeconomic inequalities in morbidity and mortality.

Socioeconomic inequalities in morbidity and mortality in western Europe

Previous studies of variation in the magnitude of socioeconomic inequalities in health between countries have methodological drawbacks. We tried to overcome these difficulties in a large study that compared inequalities in morbidity and mortality between different countries in western Europe. Data on four indicators of self-reported morbidity by level of education, occupational class, and/or level of income were obtained for 11 countries, and years ranging from 1985 to 1992. Data on total mortality by level of education and/or occupational class were obtained for nine countries for about 1980 to about 1990. We calculated odds ratios or rate ratios to compare a broad lower with a broad upper socioeconomic group. We also calculated an absolute measure for inequalities in mortality, a risk difference, which takes into account differences between countries in average rates of illhealth. Inequalities in health were found in all countries. Odds ratios for morbidity ranged between about 1.5 and 2.5, and rate ratios for mortality between about 1.3 and 1.7. For men's perceived general health, for instance, inequalities by level of education in Norway were larger than in Switzerland or Spain (odds ratios [95% CI]: 2.57 [2.07-3.18], 1.60 [1.30-1.96], 1.65 [1.44-1.88], respectively). For mortality by occupational class, in men aged 30-44, the rate ratio was highest in Finland (1.76 [1.69-1.83]), although there was no large difference in the size of the inequality in those countries with data. For men aged 45-59, for whom France did have data, this country had the largest inequality (1.71 [1.66-1.77]). In the age-group 45-64, the absolute risk difference ranked Finland second after France (9.8% [9.1-10.4], 11.5% [10.7-12.4]), with Sweden and Norway coming out more favourably than on the basis of rate ratios. In a scatter-plot of average rank scores for morbidity versus mortality. Sweden and Norway had larger relative inequalities in health than most other countries for both measures; France fared badly for mortality but was average for morbidity. Our results challenge conventional views on the between-country pattern of inequalities in health in western European countries.

Measuring social inequalities in health in the United States: a historical review, 1900-1950.

For over two centuries, U.S. vital statistics routinely have been stratified by age, sex, and race, but not by social class. The usual explanation is that U.S. government officials have not considered social class relevant to health. During the first third of the 20th century, however, questions of socio-economic inequalities in morbidity and mortality ranked high on the agenda of federal and other public health agencies, and routine reporting of U.S. vital statistics and health survey data by socioeconomic measures was nearly institutionalized. This history has largely been lost. In this article, the authors focus on the period from 1900 to 1950 and examine how public health researchers and agencies conceptualized and analyzed socioeconomic inequalities in health. Highlights include production, for 1930, of the first U.S. national death rates stratified by social class, in work sponsored by the National Tuberculosis Association and Bureau of the Census, and the Public Health Service's 1935-1936 National Health Survey, which reported morbidity data stratified by socioeconomic measures. Efforts like these were cut short by the onset of World War II and their legacy erased by the Cold War. Recovering this rich history can help inform current debates about collecting and evaluating data on social inequalities in health.